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Extended transsphenoidal operation for giant and invasive pituitary adenomas.

Ren-zhi WANG ; Jian YIN ; Chang-bao SU ; Zu-yuan REN ; Yong YAO ; Wei TAO

Chinese Journal of Surgery.2006;44(22):1548-1550.

OBJECTIVETo evaluate the possibility of extended transsphenoidal approach for removing the giant and invasive pituitary adenomas.

METHODSThe clinical data of 64 cases with giant and invasive pituitary adenoma treated by extended transsphenoidal approach were studied retrospectively.

RESULTSAmong 64 patients, 51 had total resection and 13 had subtotal resection. 26 patients occurred transient diabetes insipidus, 5 patients with transient cerebrospinal rhinorrhoea and 1 patient occurred acute hypopituitarism postoperatively. There were no death or intracranial infection. After operation, 8 patients get radiotherapy, 6 patients receive medicine treatment. Postoperative follow-up period was 3 months to 6 years. No regrowth or recurrence was seen.

CONCLUSIONThe extended transsphenoidal approach has been proved to a safe and effective method to remove the giant and invasive pituitary adenomas. Patients who got subtotal resection need be close followed-up and receive radiotherapy or medicine treatment it necessary.

Adenoma ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Male ; Microsurgery ; Middle Aged ; Neoplasm Invasiveness ; Neuroendoscopy ; Pituitary Neoplasms ; pathology ; surgery ; Sphenoid Sinus ; surgery ; Treatment Outcome

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The microsurgical anatomy of the suprasellar and parasellar region with reference to extend transsphenoidal approach.

Jian YIN ; Chang-bao SU ; Ren-zhi WANG ; Xiang-en SHI ; Hong-jin SUI ; Wen-jian MENG ; Jie LIU ; Hai QIAN

Chinese Journal of Surgery.2006;44(22):1543-1547.

OBJECTIVEThe anatomic features of transsphenoidal approach are reviewed, focusing on the microsurgical anatomy of suprasellar and parasellar structures. Pertinent microsurgical anatomy is described for neurosurgeons to successfully extend a standard transsphenoidal approach for treatment of lesions including the region of the tuberculum sellae, planum sphenoidale, supradiaphragmatic intradural space, and medial cavernous sinus.

METHODS15 specimens (30 sides) from formalin fixed cadaveric heads and 20 adult dry skulls (40 sides) were observed. According to the need for the extend transsphenoidal approach, the sellar and parasellar region: the planum sphenoidale and the supradiaphragmatic area, medial part of cavernous sinus were studied. Special emphases were put on the relation of the cranial nerve and blood vessel structures surrounding the sellar. Meanwhile, we made the cast specimen of the blood vessel and studied the structure character of the internal carotid artery in the cavernous sinus.

RESULTSPosterior ethmoidal could be exit as para or suprasphenoidal ethmoidal air cell. It will be important for extending the transsphenoidal approach. The mean distance between two optic canal is 15.7 +/- 3.2 mm (11.0 - 18.0 mm), the distance of internal carotid artery at tuberculum cellae level is 13.9 +/- 3.8 mm (10.0 - 17.0 mm), the mean distance between tuberculum cellae and the posterior rim of cribriform plate is 23.3 +/- 3.2 mm, the included angle between sagittal plane and optic canal is 36.3 degrees +/- 1.6 degrees , with the anatomy research data give the clue that the bone window should be made as the shape of "[see text]".

CONCLUSIONSExpending transsphenoidal approach is suitable for medium and small lesions growing along the centre line which expand to para sellar, anterior sellar and sphenoid platform. That hypophysis has close relation with internal carotid artery during expending transsphenoidal approach to cavernous sinus increase the risk of operation. The carotid artery and abducent nerve are the easiest structures to be damaged during the operation.

Adult ; Cadaver ; Cavernous Sinus ; anatomy & histology ; surgery ; Humans ; Sphenoid Bone ; anatomy & histology ; surgery ; Sphenoid Sinus ; anatomy & histology ; surgery

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Simultaneous off-pump coronary artery bypass surgery and pulmonary resection.

Xue-feng QIU ; Nian-guo DONG ; Tie-cheng PAN ; Xiang WEI ; Jia-wei SHI

Chinese Journal of Surgery.2006;44(22):1538-1540.

OBJECTIVETo summarize the experience of combined off-pump coronary artery bypass grafting (OPCAB) and pulmonary resection.

METHODSSeven patients with unstable angina or a history of myocardial infarction and pulmonary disease underwent combined OPCAB and pulmonary resection. All of them underwent coronary angiography, and neither coronary angioplasty nor stenting was feasible. OPCAB preceded the lung resections. The preferred approach to the heart and lung was by sternotomy. Left upper lobectomy was performed in 2 patients, right upper lobectomy was performed in 1 patient, right lower lobectomy was performed in 1 patient, right upper and middle bilobectomy was performed in 1 patient, left lung volume reduction surgery (LVRS) was performed in 1 patient and bilateral LVRS was performed in 1 patient.

RESULTSThere were no hospital mortality in this group of patients, however there were one late death. Sternal dehiscence occurred in 1 patient which was observed with a need for re-sternotomy and atrial fibrillation was observed in 1 patient. Five patients were diagnosed as malignant tumor by pathology test, and 2 patients were severe chronic obstructive pulmonary disease (COPD). Follow-up ranging from 2 months to 31 months was available for these patients. None of the patients showed evidence of myocardial ischemia after surgery. In one patient, who underwent right upper and middle bilobectomy, local recurrence was found at 19 months after surgery.

CONCLUSIONSOPCAB carried out simultaneously with lung resection is a safe and effective approach in patients diagnosed with concomitant coronary artery and pulmonary disease. OPCAB may decrease the incidence of postoperative complications.

Aged ; Angina, Unstable ; complications ; surgery ; Coronary Artery Bypass, Off-Pump ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Lung Diseases ; complications ; surgery ; Male ; Middle Aged ; Pneumonectomy ; adverse effects ; methods ; Postoperative Complications ; prevention & control ; Treatment Outcome

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Surgical treatment of giant coronary artery aneurysm.

Dian-yuan LI ; Shang-shou HU ; Li-zhong SUN ; Yun-hu SONG ; Wei WANG ; Shi-wei PAN ; Hong ZHAO ; Guo-hua LUO ; Yong-min LIU ; Zhi-tao QI ; Tian-fu TAO

Chinese Journal of Surgery.2006;44(22):1535-1537.

OBJECTIVETo discuss the clinical features and surgical treatments of giant coronary artery aneurysm (CAA).

METHODSFrom July 1996 to October 2004, 6 giant CAA patients were underwent surgery at Fuwai hospital. Three cases were underwent CAA resection, 2 concomitant coronary bypass, 3 reconstruction. The giant CAA was often combined with other cardiac diseases. Four cases underwent additional procedures of fistula closure, 3 aortic valve replacements, 2 aortoplasty and 1 thrombus cleaning at the same time.

RESULTSAll patients recovered uneventfully. The mean of cardiopulmonary bypass time was (144 +/- 26) min (range 67 to 207 min). Aortic cross clamping time was (104 +/- 21) min (range 56 to 172 min). Patients follow-up time occurred from 8 to 87 months (mean of 48 months). All patients were free of symptoms during follow-up. None of the patients died during the follow-up period and none of the CAA recurred.

CONCLUSIONSThe giant CAA is a serious cardiovascular disease, early diagnosis and surgical treatment are mandatory.

Adult ; Coronary Aneurysm ; pathology ; surgery ; Coronary Artery Bypass ; Coronary Vessels ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Surgical Procedures, Operative ; methods ; Treatment Outcome

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Analysis of the risk factors of acute renal insufficiency following coronary artery bypass grafting.

Xu-jun CHEN ; Ming-di XIAO ; Wen-hui FENG ; Bi-bo YANG ; Yong ZHANG ; Zhi-qian LÜ ; Da-lian LI

Chinese Journal of Surgery.2006;44(22):1532-1534.

OBJECTIVETo study the risk factors of acute renal insufficiency (ARI) following coronary artery bypass grafting (CABG).

METHODSThe clinic data of 2242 patients undertaking CABG between July 1997 and July 2006 were retrospectively analyzed, and ARI following CABG was included.

RESULTSARI occurred in 219 patients, with an incidence of 9.8%. Univariate analysis revealed that advanced age, diabetes mellitus, preoperative chronic renal dysfunction, left main disease, low left ventricular erection faction, emergency operation, on-pump CABG, ascending aortic atherosclerosis, postoperative respiratory function insufficiency and low cardiac output syndrome were significantly related to ARI following CABG, and logistic multivariate regression analysis showed that presence of advanced age (P = 0.031), preoperatively chronic renal dysfunction (CrCl or= 150 micromol/L, P = 0.041), on-pump CABG (P < 0.001), postoperative respiratory function insufficiency (P = 0.013) and low cardiac output syndrome (P = 0.004) were independent risk factors of ARI.

CONCLUSIONSAdvanced age, preoperatively chronic renal dysfunction, on-pump CABG, postoperative respiratory function insufficiency and low cardiac output syndrome are the risk factors of ARI following CABG.

Acute Kidney Injury ; epidemiology ; etiology ; China ; epidemiology ; Coronary Artery Bypass ; adverse effects ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; etiology ; Retrospective Studies ; Risk Factors

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Off-pump coronary artery bypass grafting with only bilateral internal mammary artery composite Lima-Rima Y graft.

Jun-feng YANG ; Cheng-xiong GU ; Hua WEI ; Rui LIU ; Chang-cheng CHEN ; Sheng-yu WANG ; Bo LI ; Hui HU ; Xin-sheng HUANG

Chinese Journal of Surgery.2006;44(22):1529-1531.

OBJECTIVETo improve the early and late benefits (the patency and total myocardium revascularization) of coronary artery bypass grafting, stimulate us using only bilateral internal mammary artery (BIMA) composite Lima (left internal mammary artery)-Rima (right internal mammary artery) Y graft with off-pump, here is the early evaluation.

METHODSFrom October 2002 to December 2005, 125 patients underwent off-pump coronary artery bypass grafting with the only composite grafts. The bilateral semi-skeletonization internal mammary artery pedicles composed the Y graft, the free Rima was anastomosed to the in situ Lima. The operation was performed off-pump and sequential anastomosis.

RESULTSFour hundred and thirteen grafts for 125 patients, average number of grafts per patient was 3.3. Graft flow was measured with Transit time flowmeter during operation time. All grafts were patent during operation. There was no death perioperative period.

CONCLUSIONOff-pump coronary artery bypass grafting with only bilateral internal mammary artery composite Lima-Rima Y graft is secure and feasible. The technique could achieve total arterial myocardium revascularization and avoiding any procedure on the ascending aorta.

Adult ; Aged ; Cardiovascular Diseases ; surgery ; Coronary Artery Bypass, Off-Pump ; Female ; Follow-Up Studies ; Humans ; Internal Mammary-Coronary Artery Anastomosis ; Male ; Middle Aged ; Treatment Outcome

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Results of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery.

Jian-ping XU ; Hong-wei GUO ; Sheng-shou HU ; Li-zhong SUN ; Yun-hu SONG ; Han-song SUN

Chinese Journal of Surgery.2006;44(22):1525-1528.

OBJECTIVETo evaluate effectiveness of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery.

METHODSBetween April 1999 and August 2005, 12 patients with anomalous origin of the coronary artery from the pulmonary artery underwent surgical correction. There were 8 patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), and 4 patients with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). Eight patients underwent direct aortic reimplantation, and 4 patients underwent a Takeuchi procedure (intrapulmonary artery baffle with an autologous pericardial patch). Simultaneous mitral annuloplasty was performed in 7 patients of ALCAPA with moderate and severe mitral regurgitation. One patient of ARCAPA was associated with an atrial septal defect (ASD) which was closed with an amplatzer septal occluder through right atrium under transesophageal echocardiography (TEE) without CPB.

RESULTSThere were neither early and late deaths nor postoperative complications. Follow-up of all patients ranged from 7 to 83 months (mean, 32 +/- 24 months). The left ventricular function after operation improved from a preoperative fractional shortening (FS) of 0.21 +/- 0.09 to 0.35 +/- 0.06 (P = 0.006) for patients with ALCAPA. Preoperative mitral regurgitation decreased in 7 patients of ALCAPA after mitral annuloplasty at the follow-up. All patients were doing well and their exercise tolerance improved to normal. They were free from symptoms.

CONCLUSIONSReestablishment of a two-coronary system is necessary for patients with anomalous origin of the coronary artery from the pulmonary artery. The left ventricular function improved after 2-coronary repair. We recommend that the simultaneous mitral annuloplasty should be performed at the time of operation for patients who have moderate and severe mitral regurgitation with ALCAPA. Surgical correction of ARCAPA and ARCAPA show good early and mid-term results, long-term results need to be followed up.

Adolescent ; Adult ; Aorta ; surgery ; Child ; Child, Preschool ; Coronary Vessel Anomalies ; surgery ; Coronary Vessels ; surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Pulmonary Artery ; abnormalities ; surgery ; Treatment Outcome

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Guideline for technique of coronary artery bypass.

Qing-yu WU ; Jian-ping XU ; Chang-qing GAO

Chinese Journal of Surgery.2006;44(22):1517-1524.

China ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; Humans

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Review and forecast of surgical treatment for coronary artery disease.

Ming-di XIAO ; Jian-qiang MAO

Chinese Journal of Surgery.2006;44(22):1515-1516.

Angioplasty ; history ; methods ; Cardiovascular Surgical Procedures ; history ; methods ; Coronary Artery Bypass ; history ; methods ; Coronary Artery Disease ; surgery ; Heart Transplantation ; history ; methods ; History, 20th Century ; History, 21st Century ; Humans ; Stem Cell Transplantation ; history ; methods

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Present and future of surgical treatment for pituitary adenomas.

Chang-bao SU

Chinese Journal of Surgery.2006;44(22):1513-1514.

Adenoma ; diagnosis ; surgery ; Early Diagnosis ; Endoscopy ; Forecasting ; Humans ; Microsurgery ; Pituitary Neoplasms ; diagnosis ; surgery ; Radiosurgery ; Surgical Procedures, Operative ; methods ; trends

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